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DOI: 10.1055/s-0037-1603804
A Less Invasive Approach to Periacetabular Osteotomy Improves Patient Reported Outcomes without Compromising Orientation
Publication History
28 April 2017
08 May 2017
Publication Date:
14 June 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00031934/201702/lookinside/thumbnails/10-1055-s-0037-1603804_170008oa-1.jpg)
Abstract
A less-invasive modification of the approach to periacetabular osteotomy (PAO) has recently been popularized by sparing the rectus femoris origin (RS-PAO). The RS-PAO approach with its lack of intra-articular inspection and associated treatment is novel, and there are few published results on the outcomes following this technique. We report on a consecutive series of RS-PAO cases, including patient reported outcomes (PROs), acetabular fragment reorientation, and complications. We reviewed a consecutive series of 103 patients (103 procedures) who underwent RS-PAO from June 2012 to January 2016 with a mean 2-year follow-up. We collected PROs, radiographic, and clinical outcomes. PROs consisted of PROMIS (Patient Reported Outcomes Measurement Information System) measures covering the domains of physical function, mental health, and a numeric pain score (NPS). Physical function and mental health were reported as standardized T-scores. Appropriate bivariate statistics were used for the analyses. Physical function improved from a preoperative mean of 39.9 (95% confidence interval [CI], 38.0–42.0) to a postoperative value of 50.0 T-score units (95% CI, 47.01–52.7; dav = 1.2). The PROMIS global mental-health T-scores improved from a preoperative median of 45.8 (interquartile range [IQR], 41.1–50.8) to a postoperative value of 53.3 (IQR, 50.8–59.0; p < 0.001, correlation coefficient [r] = 0.77). Pain decreased from a median preoperative value of 6 (IQR, 3–8) to a postoperative value of 2 (IQR, 1–3; p < 0.001, r = 0.71). The postoperative acetabular index (AI) was within the correction goal in 75% of the cases (77/103) and lateral center-edge angle (LCEA) was within goal in 87% (90/103) of the cases. Complications included intraoperative ischial fracture (n = 1), nonunion of the superior ramus (n = 1), ischiofemoral impingement (n = 1), delayed union (n = 1), and wound dehiscence (n = 2). There have been no reoperations for intra-articular pathology. The data demonstrated that using the RS-PAO technique without concomitant intra-articular work allows for appropriate acetabular positioning as well as significant improvement in physical function, mental health, and pain with an acceptable short-term complication profile and low rate of reoperation.
Keywords
rectus-sparing periacetabular osteotomy - patient reported outcomes - acetabular reorientation - complicationsNote
Each author certifies that his or her institution approved the human protocol for this investigation and all investigations were conducted in conformity with ethical principles of research. Also, informed consent for participation in the study was obtained.
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References
- 1 Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; (232) 26-36
- 2 Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res 1999; (363) 21-32
- 3 Murphy SB, Millis MB, Hall JE. Surgical correction of acetabular dysplasia in the adult. A Boston experience. Clin Orthop Relat Res 1999; (363) 38-44
- 4 Tibor LM, Sink EL. Periacetabular osteotomy for hip preservation. Orthop Clin North Am 2012; 43 (03) 343-357
- 5 Troelsen A, Elmengaard B, Søballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am 2009; 91 (09) 2169-2179
- 6 Trousdale RT, Cabanela ME. Lessons learned after more than 250 periacetabular osteotomies. Acta Orthop Scand 2003; 74 (02) 119-126
- 7 Hussell JG, Mast JW, Mayo KA, Howie DW, Ganz R. A comparison of different surgical approaches for the periacetabular osteotomy. Clin Orthop Relat Res 1999; (363) 64-72
- 8 Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 2003; 85-A (02) 278-286
- 9 Bernstein P, Thielemann F, Günther KP. A modification of periacetabular osteotomy using a two-incision approach. Open Orthop J 2007; 1: 13-18
- 10 Pajarinen J, Hirvensalo E. Two-incision technique for rotational acetabular osteotomy: good outcome in 35 hips. Acta Orthop Scand 2003; 74 (02) 133-139
- 11 Søballe K, Troelsen A. Approaches and perioperative management in periacetabular osteotomy surgery: the minimally invasive transsartorial approach. Instr Course Lect 2013; 62: 297-303
- 12 Troelsen A, Elmengaard B, Søballe K. Comparison of the minimally invasive and ilioinguinal approaches for periacetabular osteotomy: 263 single-surgeon procedures in well-defined study groups. Acta Orthop 2008; 79 (06) 777-784
- 13 Novais EN, Kim YJ, Carry PM, Millis MB. The Bernese periacetabular osteotomy: is transection of the rectus femoris tendon essential?. Clin Orthop Relat Res 2014; 472 (10) 3142-3149
- 14 Peters CL, Erickson JA, Anderson MB, Anderson LA. Preservation of the rectus femoris origin during periacetabular osteotomy does not compromise acetabular reorientation. Clin Orthop Relat Res 2015; 473 (02) 608-614
- 15 Ginnetti JG, Pelt CE, Erickson JA, Van Dine C, Peters CL. Prevalence and treatment of intraarticular pathology recognized at the time of periacetabular osteotomy for the dysplastic hip. Clin Orthop Relat Res 2013; 471 (02) 498-503
- 16 Cella D, Riley W, Stone A. , et al; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol 2010; 63 (11) 1179-1194
- 17 Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009; 18 (07) 873-880
- 18 Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J. ; Academic Network for Conservational Hip Outcomes Research Group. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 2012; 470 (08) 2220-2226
- 19 Pereira F, Giles A, Wood G, Board TN. Recognition of minor adult hip dysplasia: which anatomical indices are important?. Hip Int 2014; 24 (02) 175-179
- 20 Anderson LA, Gililland J, Pelt C, Linford S, Stoddard GJ, Peters CL. Center edge angle measurement for hip preservation surgery: technique and caveats. Orthopedics 2011; 34 (02) 86
- 21 Clohisy JC, Carlisle JC, Beaulé PE. , et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 2008; 90 (Suppl. 04) 47-66
- 22 Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am 2006; 88 (09) 1920-1926
- 23 Bouttier R, Morvan J, Mazieres B. , et al. Reproducibility of radiographic hip measurements in adults. Joint Bone Spine 2013; 80 (01) 52-56
- 24 Carlisle JC, Zebala LP, Shia DS. , et al. Reliability of various observers in determining common radiographic parameters of adult hip structural anatomy. Iowa Orthop J 2011; 31: 52-58
- 25 Mast NH, Impellizzeri F, Keller S, Leunig M. Reliability and agreement of measures used in radiographic evaluation of the adult hip. Clin Orthop Relat Res 2011; 469 (01) 188-199
- 26 Monazzam S, Bomar JD, Cidambi K, Kruk P, Hosalkar H. Lateral center-edge angle on conventional radiography and computed tomography. Clin Orthop Relat Res 2013; 471 (07) 2233-2237
- 27 Tan L, Aktas S, Copuroglu C, Ozcan M, Ture M. Reliability of radiological parameters measured on anteroposterior pelvis radiographs of patients with developmental dysplasia of the hip. Acta Orthop Belg 2001; 67 (04) 374-379
- 28 Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 2013; 4: 863
- 29 Cohen J. Quantitative methods in psychology a power primer. Psychol Bull 1992; 112 (01) 155-159
- 30 Rosenthal R. Parametric measures of effect size. In: Cooper H, Hedges LV. eds. The Handbook of Research Synthesis. New York: Russell Sage Foundation; 1994
- 31 Clohisy JC, Ackerman J, Baca G. , et al. Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study. J Bone Joint Surg Am 2017; 99 (01) 33-41
- 32 Khan OH, Malviya A, Subramanian P, Agolley D, Witt JD. Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J 2017; 99-B (01) 22-28
- 33 Lara J, Tobar C, Besomi J. Bernese periacetabular osteotomy for hip dysplasia. A modification to original technique and South American perspective. Curr Rev Musculoskelet Med 2014; 7 (04) 337-341